1. The State of Thoracic Surgery 2014
Prof Anthony Linegar PhD
Thoracic Surgeon
Hannes Meyer Registrar Symposium 2015 July.
For the development of thoracic surgery in South Africa

2. Specialist thoracic surgeons
Province
Unit
Pop served (m)
CTS
TS only
TS some
TS WTE
1 WTE : pop million GP
Wits
6.6 7
1.1
6.0
Pretoria 4 1
0.1
66.0
Medunsa 5
2.5
2.6
KZN
Dbn
10.6 9
1.6 WP
UCT
2.7
1.5
1.8 US 3
0.5
5.4 FS
UFS 2
0.8
5.0 NC KH
2.2 EC PE 6
2.1
2.9
Total 48 46 35
10.7
4.5

3. Thoracic beds Province Pop served (m) CTS beds TS beds CTS ICU beds
Bed : population
Beds : million GP 20 92 45 22
2.3
KZN
10.6
110 72 8
6.8 WP
5.4 40 19 9
3.5 FS 4 10
2.5 NC
1.1 s
55 000
18.2 EC 6 32
3.7
Total 48
314
188
3.9

4. Operation slates Province Unit Pop served (m) Ops 2014 Slates per week
Slates per year
Ops per slate per year GP
Wits
6.6
416 3
144
2.9
Pretoria 68 2 96
0.7
Medunsa
730 5
240
3.0
KZN
Dbn
10.6
600 8
384
1.6 WP
UCT
2.7
415 US
236 1 48
4.9 FS
UFS 4
220
1.5 NC KH
1.1
390
4.1 EC PE 6
670
2.8
Total
RSA
3745 32
1536
2.4

5. By pathology (the big 5) Province Unit Pop served (m) Ops 2014 TB %
Inflam %
Lung ca %
Oes ca %
Trauma %
Total % GP
Wits
6.6
416 35 30 10 15 90
Pretoria 68 1 20 91
Medunsa
730 25 16 21 93
KZN
Dbn
10.6
600 27
2.5
100 WP
UCT
2.7
415 85 US
236 14 28 5 83 FS
UFS 4
220 95 NC KH
1.1
390 EC PE 6
670 23 7 96
Total 48
3745 29 22

6. Inflammatory lung disease surgery
Province
Unit
Pop served (m)
Ops 2014 TB
Inflam
All Inflam
Total
Resections GP
Wits
6.6
416 35 30 65
270
Pretoria 68 70 48
Medunsa
730 25 16 41
299
150
KZN
Dbn
10.6
600 10 40
240
127 WP
UCT
2.7
415 20 50
208 19 US
236 14 28 42 99 26 FS
UFS 4
220
143 NC KH
1.1
390 45
176
117 EC PE 6
670 23 15 38
255
3745 29 22 53
1985
439

7. Lung cancer BOD for lung cancer resections = 750 per year
Province
Unit
Pop served (m)
Ops 2014
Lung CA %
Total cases
Resections GP
Wits
6.6
416 10 42
Pretoria 68 1
Medunsa
730 21
153
KZN
Dbn
10.6
600 27
162 9 WP
UCT
2.7
415 8 US
236 5 12 FS
UFS 4
220 20 44 3 NC KH
1.1
390 15 59 EC PE 6
670 28
188
Total 48
3745
570 46
BOD for lung cancer resections
= per year
= procedures per year

8. Oesophagus cancer BOD for oesophagus resections = 650 per annum
Province
Unit
Pop served (m)
Ops 2014
Oes CA %
Total cases
Resect GP
Wits
6.6
416
Pretoria 68
Medunsa
730
1.5 11 4
KZN
Dbn
10.6
600 30
180 9 WP
UCT
2.7
415 15 62 8 US
236 35 1 FS
UFS
220 NC KH
1.1
390 5 20 EC PE 6
670 23
154 2
Total 48
3745 10
372 28
BOD for oesophagus resections
= per annum
= cases per year

9. Trend operations per annum
Province
Unit
Pop served (m)
2002
2003
2004
2005
2006
Ops 2014 GP
Wits
6.6
nda
413
416
Pretoria 68
Medunsa
210
730
KZN
Dbn
10.6
1462
1205
1060
1021
1186
600 WP
UCT
2.7
549
463
460
176
268
415 US
404
442
236 FS
UFS 4 90
132
175
190
220 NC KH
1.1
390 EC PE 6
670
Total 48
2011
2162
1652
1814
2730
3745

10. Summary 48 million population 46 CTS and 35 do some TS
9 X WTE
48 million population
46 CTS and 35 do some TS
4 beds per million
32 slates per week and 2.4 operations per slate
3745 operations in Inflammatory 55% Lung ca 15% Oesophagus ca 10% Trauma 15%
10.7 WTE
1 TS per 4.5m population
1TS per – population
3 x BEDS
1 bed per
5 -6 beds per to
16 hrs of theatre per TS per week (4 slates)
3 hours endoscopy per week
3 X SLATES
Performance gap
1:20
Target ~ 700 per unit
or 5400 in total
Waiting times 2 weeks referral to
consultation and 3-4 weeks to surgery
from time of diagnosis
1000 cases

11. Looking ahead - Few people, small steps, big plan?
It is possible, its worthwhile and its do-able right now.
It will be to the credit of all role players and the lasting benefit of the patients and the community.
How do we make this fit in with healthcare priorities for RSA?
How do we get buy in and build teams at all levels?
What is the next step?
For the development of thoracic surgery in South Africa